Patient Exposures with Imaging Patient Radiation Exposure ... · Exam Information Database Dosimetry Analyzer Emails WAN Dose Tracking System DICOM, HL7 Gateway DICOM DICOM SR HL7

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©2011 MFMER | slide-1

Patient Radiation Exposure Tracking with an Automated Database

William Pavlicek PhDDept of RadiologyMayo Clinic Arizona

AAPM /COMP Meeting Vancover, BCJuly-Aug 2011

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Patient Exposures with Imaging

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Options Exist: Tracking Patient Exposure

• Siemens

• Philips

• General Electric

• Toshiba

• Radiance

• others

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Tracking Medical Radiation Exposure

• As a Quality Control Tool (Six Sigma)

• Establish Reference Levels for routinely performed exams and procedures

• Source of patient summary of exposures

• Recognize outliers (DMAIC)

• Provide Immediate Alerts for QA directed occurances (Level II Reference Levels)

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System Architecture

Knowledge Base

Exam

Information Database

Dosimetry Analyzer

Emails

WAN

Dose

Tracking

SystemDICOM, HL7 Gateway

DICOM DICOM SR HL7

Texts

Reporting &

Alerting Module

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DICOM tags and DICOM RDSRCommon tags, e.g.

(0010, 0010) Patient's Name

(0008, 1030) Study Description

(0008, 0060) Modality

(0008, 0032) Acquisition Time

Application-related tags

Peak Skin Dose, e.g.

(0018,115E) Area Kerma Product (KAP)

(0018,1510) Positioner Primary Angle

Mammography, e.g.

(0040, 0316) Organ Dose

(0018,7060) Exposure Control Mode

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Fluoroscopically Guided Procedures

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Peak Skin Dose not related to Fluoroscopy Time

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Fluoroscopy: DICOM RD SRPatient having 287 separate ‘events’

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DICOM & Info Primary angleSecondary

angle

Table Longitudinal

Position

Table Lateral

Position

Table Height

PERP (mGy)

Local dosemGy @ skin

FLUOROUSE

Fluoroscopy Event 1

Fluoroscopy Event 2

Fluoroscopy Event 3

Fluoroscopy Event 4

-17 4.5 -21.8 672 130 1.3

-0.2 4.6 -28.2 612 130 3.4

0.9 4.4 -23.1 583 130 6.3

32.7 4.8 -23.1 576 130 13.3

DSAUSE

Acquisition Event 1

Acquisition Event 2

Acquisition Event 3

Acquisition Event 4

-0.2 4.6 -9.6 640 130 179.7

0.9 4.4 -0.6 702 130 78.7

0.9 4.4 -27.9 568 130 312.0

32.7 4.8 -23.1 576 130 358.5

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Example – Simple Geometry

Ka,r = 5 Gy

Machine correction = 0.85BSF = 1.4Tissue/Air = 1.06Ref Pt/Skin = ‘0’Table/Pad = 0.7

PSD = 4.4 Gy

Both Fluoro AND

Acquistions needed!

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PSD using Informatics: Virtual (reference) Patients

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Define Virtual Equipment

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Table attenuation factor: 0.8; Machine correction factor: 0.8; Backscatter factor: 1.4.

IDGend

erProcedure

KAP/air kerma (cm2)

Number of the scans

Number of Fluoro

Peak skin dose

area>=0.95 peak skin dose (cm2)

Total area radiated

(cm2)

Lateral inc (cm)

Long inc (cm)

1234567890 fIR Emobalization

(non-Neuro)245.7 180 162 4.3 Gy 18 1068 6 25

Clinical Example

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General Search: PSD Exceeding 2GyPATIENT_NAME PATIENT_ID M/F AGE ACCESSION DICOM_EXAM_UID PSD EXAM_DATE

TESTING^JOE 55505479 M 73 555063793-1 1.2.124.113532… 2.12 2001.01.03

TESTY^SMITH 55500348 M 84 555028234-1 1.2.124.113532… 2.06 2001.01.04

PHANTOM^JANE 55503229 M 76 555075490-1 1.2.124.113532… 2.24 2001.01.05

TESTT^JOE 55502419 M 71 555051025-1 1.2.124.113532… 2.77 2001.01.06

PHANTOMS^SMITH 55509381 M 68 555069339-1 1.2.124.113532… 3.71 2001.01.07

TESTS^TEST 55507826 M 82 555085478-1 1.2.124.113532… 2.16 2001.01.08

TESTIE^JOE 55509396 F 89 555048986-1 1.2.124.113532… 5.63 2001.01.09

REFER_DOC RADIOLOGIST EXAM_DESCRIP CAMPUS OPERATOR STUDY_TIME

BLUE^DOC GRAY^DOC Vas Aorta MCS TECH 20:19.0

GREEN^DOC GRAY^DOC Vas Aorta MCH TECH 21:13.0

BLUE^DOC GRAY^DOC Aorta MCH TECH 00:51.0

ORANGE^DOC GRAY^DOC Vas Aorta MCH TECH 18:29.0

WHITE^DOC GRAY^DOC Vas Aorta MCH TECH 26:00.0

WHITE^DOC GRAY^DOC Mesenteric MCH TECH 22:55.0

ORANGE^DOC GRAY^DOC Vas Aorta MCH TECH 17:20.0

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Mammography

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~2.4 mGy for previous Analog

Distribution of Average Glandular Dose

0

200

400

600

800

1000

1200

0.6 - 0.8 0.9 - 1.1 1.2 - 1.4 1.5 - 1.7 1.8 - 2.0 2.1 - 2.3 2.4 - 2.6 > 2.6

Average Glandular Dose (mGy)

Nu

mb

er

of

Exp

osu

res

1.27 mGy for GE FFDM

~2.4 mGy for previous Analog

Average Glandular Dose

Mean = 1.27 mGy

Min = 0.48 mGy / Max = 7.04 mGy

* radiation concentration delivered to the breast tissue (“glandular tissue”) *

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FFDM unit selected Rh/Rh Target/Filter combination for vast majority of phototimed exposures (surprising selection was so lop-sided)

What does this tell us about our study population?

FFDM unit designed to optimize SNR for detector (explains frequent use of Rh/Rh)

Mo/Mo: ~86% of exposures used 26 kVp

Mo/Rh: ~72% of exposures used 27 kVp

Rh/Rh: ~80% of exposures used 29 kVp

T/F% of Total

# Exposures

Most Common

kVp for T/F

Selection

Most Common kVp as

% of Exposures with

Selected T/F

Mo/Mo 1.19% 26 85.71%

Mo/Rh 14.04% 27 72.21%

Rh/Rh 84.78% 29 80.39%

Anode – Filter Section

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Computed Tomography

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Exam Description (RIS) Protocol Description(Scanner)

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CT Protocol: 6110 Abd liv tri Pel

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PerfusionAlerts

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Alert: CT Perfusion

Trigger:

Rule: CT time greater than 30 seconds

or: kVp(0018,060) higher than 80kV

or: Exposure (0018,1152) higher than 320 mAs.

Alert:

Email to [email protected], DL Rad Trac

One Mayo

Implementation

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Nuclear and PET and PET/CT

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Source of Nuclear Data HL7

PATIENT

REGISTER

PATIENT

LIST

mCi admin

EXAMS

(HL7)

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Nuclear/PET HL7 Data stream

......

MSH|^~\&|HL7|Nuclear Medicine

Lab|||20110714122909||ORU^R01|201107141229094|P|2.3|||||||

PID|||075630111||TestyPerson,Martha||19290420000000|M|||^^^^^||||||||||

|||||||||

OBR|||542533466-1|NM PET/CT Whole Body^NM PET/CT Whole

Body||||||||||||||||||||||||||||||||20110714122209|||||||

ZDD|F-18 BULK

VIAL|DoseDrawnActivity^10.0|DoseDrawnActivityUnits^mCi|Whole

Body^700.00^mRads^361,490.0^kBq||| 7.0^mSv|||||||||||||||||||||||||

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Mayo Dosage

MBq mCi

Capromab Pendetide Prostascint

Brain Death 740 20

Heart First Pass Only 370 10

Lung Ventilation 1480 40

Liver Scan 240.5 6.5

Cystogram 37 1

Esophageal Transit 7.4 3 doses 200uCi 3 doses

Gastric Emptying 37 1

Liver Scan 240.5 6.5

Peritoneal Distribution 74 2

Skeletal Bone Marrow 370 10

Breast Sentinel Lymph Node 37 1

Lymphedema Scan 18.5 2 doses 500uCi 2 doses

Melanoma Lymph Node 74 or 148 2 or 4

Hepatobiliary 148 4 Tc 99m Mebrofenin Chloletec

Kidney 370 10 Tc 99m Mertiatide TechneScan MAG3

Hepatic Artery 148 4

Lung Perfusion 222 6

Portal Venous Shunt 148 4

Tc 99m Exametazime Ceretec

Brain Spect Scan 925 25

Brain Death 740 20

SISCOM Protocol 555-1295 15-35

Diagnostic

Sulfur Colloid

Chemical Name Common NameProcedure

Tc 99m Penteate DTPA

Tc 99m Albumin Aggregated MAA Albumin Aggregated

Tc 99m Sulfur Colloid

Tc 99m Bicisate Neurolite

2.7 (rads/5mCi)

0.2 (rads/10mCi)

0.666 Bladder Wall 6.14 10.4 4.51 0.007

0.26 (rads/20mCi) Kidneys 2.52 19.2 6.88 0.0093

212.22Spleen0.15 (rads/8mCi)

Package Insert First Organ Dose RADAR

Rad mGy mSV mSV/MBqNormal Dose mSV Organ

0.011

.03 (rads/5mCi) Bladder Wall 2.99 2.99

1.632.370.977

1.81 0.0049

0.00942.78

Bladder Wall

Lungs0.060 (rad/4mCi)

20 8.14 0.0115.4

Stabin, M "Adults-Doses per Unit Activity." Radiation Dose Assessment Resource. 2001.

Web. 9 June 2011. http://www.doseinfo-Radar.com/NMdoses.xls.

Nuclear – PET Dosimetry

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Challenges and Goal

• Different data types

• Different modalities

• Different medical imaging vendor content

• Huge amount of data

• Value

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Team Members and I ‘Thank you’!

Dr. Muhong Zhang,

ASU

Dr. Eric Huettl,

MCA

Dr. Brian Chong,

MCA

Gene Paden, MS.,

MCA

Dr. Teresa Wu,

ASU

Yasaman

Khodadadegan

Stephen Sabyan,

R.T. (R), MCA

Dr. Richard Morin,

MCJ

Dr. Kevin

Nelson, MCJ

Dr. Beth

Schueler, MCR

Dr. Steve

Langer, MCR

Dr. Kenneth

Fetterly, MCR